Pharmacopsychiatry 2017; 50(05): 189-196
DOI: 10.1055/s-0043-112755
Review
© Georg Thieme Verlag KG Stuttgart · New York

Influence of Long-Term Benzodiazepine use on Neurocognitive Skills Related to Driving Performance in Patient Populations: A Review

Nick N. J. J. M. van der Sluiszen
1   Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
,
Annemiek Vermeeren
1   Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
,
Stefan Jongen
1   Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
,
Frederick Vinckenbosch
1   Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
,
Johannes G. Ramaekers
1   Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
› Author Affiliations
Further Information

Publication History

received 10 March 2017
revised 24 May 2017

accepted 25 May 2017

Publication Date:
04 July 2017 (online)

Abstract

Acute benzodiazepine intoxication produces severe impairment of neurocognitive skills related to driving. It is less clear whether such impairments also occur in patients who use benzodiazepines chronically. The current review evaluated neurocognitive skills of long-term benzodiazepine users and addressed 2 major questions: do long-term users develop tolerance for the impairing effects of benzodiazepines on neurocognitive performance, and if so, does tolerance warrant a change in driver fitness classification systems that currently deem users of benzodiazepines unfit to drive? Neurocognitive impairments were reported in patients who on average used benzodiazepines for 5–15 years. In addition, sensitivity to acute benzodiazepine impairment decreased in long-term users, suggesting (partial) tolerance. Definitions of clinical relevance of neurocognitive impairments in long-term users and how these were affected by duration of benzodiazepine use were generally lacking. Also, sensitivity of neurocognitive tasks to drug effects and their validity to predict fitness to drive were generally unknown. Because of these limitations, no firm conclusion can be drawn regarding a re-classification of long-term benzodiazepine effects on driver fitness.

 
  • References

  • 1 Lader M. Benzodiazepines revisited—will we ever learn?. Addict 2011; 106: 2086-2109
  • 2 Cloos JM, Ferreira V. Current use of benzodiazepines in anxiety disorders. Curr Opin Psychiatry. 2009; 22: 90-95
  • 3 Morin AK, Jarvis CI, Lynch AM. Therapeutic options for sleep-maintenance and sleep-onset insomnia. Pharmacotherapy 2007; 27: 89-110
  • 4 Carvey P. Drug Action in the central nervous system. Oxford: University Press; 1998: 123-150
  • 5 Vermeeren A. Residual effects of hypnotics. CNS Drugs 2004; 18: 297-328
  • 6 Barbone F, McMahon A, Davey P. et al. Association of road-traffic accidents with benzodiazepine use. Lancet 1998; 352: 1331-1336
  • 7 Ray WA, Fought RL, Decker MD. Psychoactive drugs and the risk of injurious motor vehicle crashes in elderly drivers. Am J Epidemiol. 1992; 136: 873-883
  • 8 Dubois S, Bedard M, Weaver B. The impact of benzodiazepines on safe driving. Traffic Inj Prev 2008; 9: 404-413
  • 9 Vermeeren A, Leufkens TR, Verster JC. Effects of anxiolytics on driving. In: Verster JC, Pandi-Perumal SR, Ramaekers JG, de Gier JJ. eds. Drugs, Driving and Traffic Safety. Basel: Birkhäuser; 2009: 289-305
  • 10 Ghoneim M, Mewaldt S, Berie J. et al. Memory and performance effects of single and 3-week administration of diazepam. Psychopharmacol 1981; 73: 147-151
  • 11 Pomara N, Tun H, DaSilva D. et al. The acute and chronic performance effects of alprazolam and lorazepam in the elderly: Relationship to duration of treatment and self-rated sedation. Psychopharmacol Bull. 1998; 34: 139-154
  • 12 O’Hanlon JF, Vermeeren A, Uiterwijk M. et al. Anxiolytics’ effects on the actual driving performance of patients and healthy volunteers in a standardized test. Neuropsychobiology 1995; 31: 81-88
  • 13 Van Laar M, Volkerts ER, van Willigenburg A. Therapeutic effects and effects on actual driving performance of chronically administered buspirone and diazepam in anxious outpatients. J Clin Psychopharmacol. 1992; 12: 86-95
  • 14 Dassanayake T, Michie P, Carter G. et al. Effects of benzodiazepines, antidepressants and opioids on driving. Drug Saf. 2011; 34: 125-156
  • 15 Smink BE, Egberts AC, Lusthof KJ. et al. The relationship between benzodiazepine use and traffic accidents. CNS Drugs 2010; 24: 639-653
  • 16 Neutel I. Risk of traffic accident injury after a prescription for a benzodiazepine. Ann Epidemiol. 1995; 5: 239-244
  • 17 Neutel I. Benzodiazepine-related traffic accidents in young and elderly drivers. Hum Psychopharmacol 1998; 13: S115-S123
  • 18 Hansen RN, Boudreau DM, Ebel BE. et al. Sedative hypnotic medication use and the risk of motor vehicle crash. Am J Public Health. 2015; 105: e64-e69
  • 19 Hemmelgarn B, Suissa S, Huang A. et al. Benzodiazepine use and the risk of motor vehicle crash in the elderly. JAMA 1997; 278: 27-31
  • 20 De Gier JJ, Alvarez FJ, Mercier-Guyon C. et al. Prescribing and dispensing guidelines for medicinal drugs affecting driving performance. In: Verster JC, Pandi-Perumal SR, Ramaekers JG, de Gier JJ. eds. Drugs, Driving and Traffic Safety. Basel: Birkäuser; 2009: 121-134
  • 21 Ravera S, Monteiro SP, de Gier JJ. et al. A European approach to categorizing medicines for fitness to drive: Outcomes of the DRUID project. Br J Clin Pharmacol. 2012; 74: 920-931
  • 22 Lucki I, Rickels K, Geller AM. Chronic use of benzodiazepines and psychomotor and cognitive test performance. Psychopharmacol 1986; 88: 426-433
  • 23 Manthey L, Loenen-Frösch F, Giltay EJ. et al. High dose benzodiazepines prolong reaction times in chronic users who have major depressive and/or anxiety disorders. Br J Clin Pharmacol. 2014; 77: 571-577
  • 24 Puustinen J, Lähteenmäki R, Polo-Kantola P. et al. Effect of withdrawal from long-term use of temazepam, zopiclone or zolpidem as hypnotic agents on cognition in older adults. Eur J Clin Pharmacol. 2014; 70: 319-329
  • 25 McAndrews MP, Weiss RT, Sandor P. et al. Cognitive effects of long-term benzodiazepine use in older adults. Hum Psychopharmacol 2003; 18: 51-57
  • 26 Sakol MS, Power KG. The effects of long-term benzodiazepine treatment and graded withdrawal on psychometric performance. Psychopharmacol 1988; 95: 135-138
  • 27 Tata PR, Rollings J, Collins M. et al. Lack of cognitive recovery following withdrawal from long-term benzodiazepine use. Psychol Med. 1994; 24: 203-213
  • 28 Golombok S, Moodley P, Lader M. Cognitive impairment in long-term benzodiazepine users. Psychol Med. 1988; 18: 365-374
  • 29 Gorenstein C, Bernik M, Pompéia S. et al. Impairment of performance associated with long-term use of benzodiazepines. J Psychopharmacol. 1995; 9: 313-318
  • 30 Leufkens T, Ramaekers J, de Weerd A. et al. On-the-road driving performance and driving-related skills in older untreated insomnia patients and chronic users of hypnotics. Psychopharmacol 2014; 231: 2851-2865
  • 31 Vignola A, Lamoureux C, Bastien CH. et al. Effects of chronic insomnia and use of benzodiazepines on daytime performance in older adults. J Gerontol B 2000; 55: P54-P62
  • 32 Voshaar RCO, Verkes RJ, van Luijtelaar GL. et al. Effects of additional oxazepam in long-term users of oxazepam. J Clin Psychopharmacol. 2005; 25: 42-50
  • 33 Pomara N, Lee SH, Bruno D. et al. Adverse performance effects of acute lorazepam administration in elderly long-term users: Pharmacokinetic and clinical predictors. Prog Neuropsychopharmacol Biol Psychiatry. 2015; 56: 129-135
  • 34 Leufkens T, Ramaekers J, de Weerd A. et al. Residual effects of zopiclone 7.5 mg on highway driving performance in insomnia patients and healthy controls: A placebo controlled crossover study. Psychopharmacol 2014; 231: 2785-2798
  • 35 Bierman E, Comijs H, Gundy C. et al. The effect of chronic benzodiazepine use on cognitive functioning in older persons: Good, bad or indifferent?. Int J Geriatr Psychiatry 2007; 22: 1194-1200
  • 36 Paterniti S, Dufouil C, Alpérovitch A. Long-term benzodiazepine use and cognitive decline in the elderly: The epidemiology of vascular aging study. J Clin Psychopharmacol. 2002; 22: 285-293
  • 37 Blomberg RD, Peck RC, Moskowitz H. et al. The long beach/fort lauderdale relative risk study. J Safety Res. 2009; 40: 285-292
  • 38 Borkenstein RF, Crowther R, Shumate R. The role of the drinking driver in traffic accidents (The Grand Rapids Study). Blutalkohol 1974; 11: 1-131
  • 39 Kay GG, Logan BK. Drugged driving expert panel report: A consensus protocol for assessing the potential of drugs to impair driving. Washington, DC: National Highway Traffic Safety Administration; 2011
  • 40 Jongen S, Vuurman E, Ramaekers J. et al. The sensitivity of laboratory tests assessing driving related skills to dose-related impairment of alcohol: A literature review. Accid Anal Prev 2016; 89: 31-48
  • 41 Ramaekers JG. Antidepressants and driver impairment: Empirical evidence from a standard on-the-road test. J Clin Psychiatry. 2003; 64: 20-29
  • 42 Verster JC, Roth T. Predicting psychopharmacological drug effects on actual driving performance (SDLP) from psychometric tests measuring driving-related skills. Psychopharmacol 2012; 220: 293-301